- PO (Adults ≥50 kg): Immediate-release: 4–8 mg every 3–4 hr initially (some patients may respond to doses as small as 2 mg initially); or once 24-hr opioid requirement is determined, convert to extended-release by administering total daily oral dose once daily.
- PO (Adults and Children <50 kg): 0.06 mg/kg every 3–4 hr initially, younger children may require smaller initial doses of 0.03 mg/kg. Maximum dose 5 mg.
- IV, IM, SC (Adults ≥50 kg): 1.5 mg every 3–4 hr as needed initially; may be ↑.
- IV, IM, SC (Adults and Children <50 kg): 0.015 mg/kg mg every 3–4 hr as needed initially; may be ↑.
- IV (Adults): Continuous infusion (unlabeled): 0.2–3 mg/hr depending on previous opioid use. An initial bolus of twice the hourly rate in mg may be given with subsequent breakthrough boluses of 50–100% of the hourly rate in mg.
- Rect (Adults): 3 mg every 6–8 hr initially as needed.
Hepatic Impairment
- PO (Adults): Moderate hepatic impairment (extended–release): ↓ initial dose by 75%.
Renal Impairment
- PO (Adults): Moderate renal impairment (extended–release): ↓ initial dose by 50%; Severe renal impairment (extended–release): ↓ initial dose by 75%.
